Suppose that you are in an accident which is entirely the other
driver’s fault and your two-year-old car is totaled. Is the other
driver responsible for buying you a new car? No. When a car or
other personal property is damaged or destroyed, the measure
of damages is: How much will it cost to fix it? If it can’t be fixed,
how much is its replacement value? For instance, let’s say you
paid $25,000 for your car two years ago, but the fair market
value of a two-year-old car of the same make and model was
$17,500 at the time of the accident that destroyed your car.
Under these circumstances, the most you can recover from the
other driver is only $17,500. This is true even though you are
likely to still owe more on your car loan than $17,500. Or if the
cost of repairing your vehicle after such an accident exceeds its
fair market value, the defendant would nevertheless only have
to pay you the fair market value of the vehicle.

Likewise, if any contents you had in your car were damaged
or destroyed during the accident, the party at fault must
compensate you for their fair market value at the time of the
accident. If the party at fault is uninsured, you will ordinarily
have to recover the value of the contents by submitting a claim
to your homeowner’s insurance company.

In many personal injury cases, compensation for the physical
pain and emotional suffering you experienced and will continue
to suffer because of another person’s negligence often
constitute a significant portion of the damages you are entitled
to receive. Indeed, monetary compensation for physical and
psychological pain and suffering constitutes the lion’s share of
many personal injury awards. Note, however, that in medical
malpractice cases, awards for pain and suffering (and other
“non-economic” damages) are limited to $250,000.

The amount of compensation the jury will award for pain
and suffering depends upon the type and nature of the injury.
For instance, a jury will award a person who has suffered serious
burns over 30 percent of her body a significantly higher
amount of compensation for pain and suffering than it will
award a person who has suffered a typical whiplash injury. Pain
and suffering is a catch-all phrase that includes such things as:

  • Past and future physical pain
  • Mental suffering
  • Loss of enjoyment of life
  • Disfigurement
  • Physical impairment
  • Inconvenience
  • Grief (except in wrongful death cases)
  • Anxiety
  • Fright
  • Humiliation
  • Discomfort
  • Fear
  • Anxiety
  • Embarrassment
  • Anguish
  • Other emotional distress the victim has suffered and will
    continue to suffer in the future

The Texas Court of Appeals once stated, “In a world so full
of pain and suffering, it is strange that no one has perfected a
gauge that will accurately measure its value.”

At the end of a personal injury trial, when giving the jury its
instructions, the judge will inform the jury not to speculate and
that neither emotion nor prejudice has a place in their deliberations.
The judge further instructs the jury that the only award
permissible in a personal injury case is one lump sum for all
time, in precise, cold, hard dollars and cents. Continuing his
instructions to the jury, the judge will say further that “pain
and suffering,” “ridicule,” “humiliation,” “embarrassment,”
and the like all shall be evaluated, and only “in terms of dollars
and cents.” Then, as the jurors expectantly wait for further
instructions of what is the evaluator or yardstick of the pain
and suffering they are to award, the “kilowatt” of pain and suffering,
they learn that the judge can give them no such yardstick
because none exists. Every case must be determined on
its own merits.

After telling the jury that they must return a verdict only
in “dollars and cents” for pain and suffering, one judge said:
“Under the head of this matter of pain with suffering and
humiliation, I am unable to give you any definite rule by which
you can assess damages. However, the law allows jurors to
assess damages for pain and suffering and humiliation. Nobody
can measure pain and suffering in damages. No one can value
them particularly. If a man said to you, ‘What would you take
to suffer this or that,’ usually they would tell you they would not
take anything. There is no way of measuring pain and suffering
definitely. But I say to you, ladies and gentlemen of the jury,
it is a proper measure of damages. The only thing I can say to
you about assessing damages in this kind of case for pain and
suffering is that it is just a question of plain common sense.
One judge has said it was just a matter of plain horse sense, and
that particular statement was approved by the Supreme Court.
Allow just such a sum as you think should be allowed in dollars
and cents.”

Loss of enjoyment of life can be a major element of pain and
suffering for which monetary compensation is available in a
personal injury case. For example, assume that you’re an active
man in his mid-twenties, playing basketball and tennis several
times a week and running in the occasional marathon or taking
part in triathlons. Because of another person’s carelessness,
you suffer an injury to your right leg that, due to its severity,
prevents you from engaging in the activities you used to enjoy.
You are entitled to receive fair compensation for this “loss of
enjoyment of life.”

In California, the victim’s lawyer cannot argue to the jury
how much money they would take to trade shoes with the
injured person and ask what they would charge or expect as
compensation for the pain and suffering endured by the injured
plaintiff if it happened to them. This is known as the “Golden
Rule” argument and is considered prejudicial to the defendant.

The jury is instructed merely that they are required to award an
amount for pain and suffering that is reasonable in light of the
evidence admitted at the trial, and that they must not let bias,
sympathy, prejudice, or public opinion influence their decision.

In one case, the plaintiff’s lawyer, during closing argument,
asked the jury to assess damages from their own perspective,
to act as “a personal partisan advocate for the injured party,
rather than any unbiased and unprejudiced weigher of the evidence.”
The appellate court found this was an improper argument,
because it was essentially a plea to apply the Golden Rule
standard.

However, although the law prevents the victim’s lawyer from
asking the jury to put themselves in the victim’s place when
the injury results in an injury that will cause the victim pain
and suffering for the future, even for rest of his life, California
law permits the victim’s lawyer to argue a per diem standard to
determine the amount of her client’s compensation. Under the
per diem rule, an amount for hourly or daily pain is multiplied
by the number of hours or days of the plaintiff’s life expectancy.
For instance, the victim’s attorney can argue that the injured
victim is entitled to, say, $100 a day for his pain and suffering,
multiplied by the plaintiff’s life expectancy. This means that a
person suffering $100 per day of pain and suffering would be
entitled to compensation of $36,500 per year, multiplied by the
number of years of his life expectancy. Thus, if the plaintiff’s life
expectancy is 10 years, the plaintiff would be allowed $365,000
for pain and suffering. If his life expectancy were 20 years, he
would be allowed $730,000 and so forth.

As the California Supreme Court has stated, there is no
definite standard or method of calculation prescribed by law by
which to fix reasonable compensation for pain and suffering.
No method is available to the jury by which it can objectively
evaluate such damages, and no witness may express his subjective
opinion on the matter. In a very real sense, the jury is asked
to evaluate in terms of money a detriment for which monetary
compensation cannot be ascertained with any demonstrable
accuracy. Translating pain and suffering into dollars can,
at best, be only an arbitrary allowance, and not a process of
measurement, and consequently the judge can give the jury no
standard to go by; the judge can only tell the jury to allow such
amount as in their discretion they may consider reasonable.
The chief reliance for reaching reasonable results in attempting
to value suffering in terms of money must be the restraint and
common sense of the jury.

The jury must impartially determine pain and suffering damages
based upon evidence specific to the victim, as opposed to
statistical data concerning the public at large. The only person
whose pain and suffering is relevant in calculating a general
damage award is the victim. How others would feel if placed in
the victim’s position is irrelevant.

Monetary compensation for psychological injuries such as
Posttraumatic Stress Disorder (PTSD), depression, anxiety,
and phobias needing professional help are recoverable in most
cases with proper psychiatric or psychological care and the use
of psychoactive medications in many cases.

In one automobile accident case, a father and his 16-yearold
daughter were seriously injured in a horrendous head-on
collision. However, a 15-year-old cousin who was sitting in
the back seat with her seatbelt on escaped with just a few cuts
and bruises. The newspaper that covered the crash dubbed her
lack of serious injuries a “miracle.” Fast forward six months:
the father and daughter are well on their way to full recoveries.
However, things could hardly be worse for the “miracle girl”
who avoided any physical injury with nary a scratch.

Soon after the accident, the girl began getting anxious when
riding in a car. These feelings of general anxiety progressed to
full-blown panic attacks that prevented the girl from riding in
a car at all. Eventually, the girl’s anxiety and panic became so
strong that she was afraid to leave the house without a safe companion,
and she was becoming frightened of leaving the house
even with a safe person. The girl had developed a psychiatric
condition known as panic disorder with agoraphobia that rendered
her housebound. While she needed mental health care
to overcome her fears, the girl was too scared to leave home
to travel to the office of a psychiatrist or psychologist. She also
developed severe depression.

The point of this case is to demonstrate that even when a
person escapes serious physical injury, he may develop severe
psychological damages that significantly impair his functioning
in and enjoyment of life. And it doesn’t have to be a serious
accident to cause severe psychological injuries.

People who get in serious accidents can develop
Posttraumatic Stress Disorder (PTSD), the same type of anxiety
that combat soldiers often develop. The person may suffer
nightmares about being in the accident, wake up in the middle
of a summer’s night in a cold sweat, duck for cover at loud
noises such as a car backfiring, etc.

Many people who have been involved in an accident develop
major depressive disorder (MDD), even if they were not physically
harmed or suffered only superficial physical injuries. The
outgoing, high-achieving high school student who was a passenger
in a car that was involved in an accident but escaped
with only a few cuts and bruises may turn sullen, lose interest
in activities she used to enjoy, sleep too much or too little, experience
fatigue or tiredness throughout the day, feel worthless
or guilty, or have a diminished ability to think or concentrate.
At its most serious, depression may result in having recurrent
thoughts of death and suicidal ideations. In the worst case scenario,
if the depressed individual does not get adequate mental
health care in time, she may commit suicide, all stemming from
an accident she was involved in but didn’t suffer any serious
physical injuries.

Psychological damage resulting from another person’s careless
conduct is real, debilitating, and sometimes deadly. If you
find that a family member or loved one is acting differently
since he has been involved in an accident of any type, encourage
that person to see a psychiatrist or a psychologist for a
mental health evaluation. A psychiatrist is a medical doctor
(M.D.), while a psychologist is either a Ph.D. or Psy.D. Only a
psychiatrist can prescribe medication, such as antidepressants
or anti-anxiety drugs. Without a proper mental health checkup,
your loved one may suffer excruciating psychic pain and lose all
interest in others, things he used to enjoy, and even life itself.
With proper psychotherapy and/or psychoactive medication,
your loved one should be back to his old self again in several
months.

Traumatic injury is the most common reason for an amputation
among people younger than 50. The leading causes of
those injuries include motor vehicle and motorcycle accidents,
farm machines, power tools, and factory/industrial machines
and equipment. Another source can be products that are dangerously
designed, do not have sufficient safety measures built
in, and/or lack a properly placed “off” switch. Traumatic amputation
usually occurs at the scene of the accident, when the
limb is completely or partially severed. Sometimes the injured
person will make it to the hospital with the limb still attached
but so badly crushed or mangled that amputation is necessary.

The amputation may be of one or more toes or fingers, a foot
or a hand, a leg below or above the knee, or an arm below or
above the elbow. A person may sustain amputations of more
than one limb, such as both legs, both arms, or one of each. For
instance, when a person comes into contact with an exposed,
downed high-voltage power line, it is not at all unusual for the
person to suffer the amputation of more than one limb as the
electricity seeks paths to leave the body. Hemicorporectomy,
or amputation at the waist downward, is the most radical—and
rare—of all the types of amputations.

The majority of trauma-related amputations are of the arms
(approximately 65 percent compared to 35 percent for leg
amputations), and men are at a significantly higher risk than
women for trauma-related amputations. However, the number
of amputations in women is on the rise, as is the age of the
victim who requires an amputation. If an accident or other
trauma results in the complete amputation of a limb (i.e., the
body part is totally severed), that part sometimes can be reattached,
especially when proper care is taken of the severed part
and the stump. However, often the victim will have a better
outcome from having a well-fitting, functional prosthesis than
a nonfunctional reattached limb.

The long-term outcome for persons who have lost a limb has
improved greatly due to a better understanding of the management
of traumatic amputation, early emergency and critical
care management, new surgical techniques, early rehabilitation,
and new prosthetic designs. But make no mistake about
it: the loss of a limb is still a serious injury that requires major
changes to your life. No amount of money and no prosthesis
can ever replace a natural, fully functional limb.
Severe and persistent pain can be a fact of life for someone
who has suffered a traumatic amputation. Up to 80 percent of
all amputees still experience pain in their residual limb (the
“stump”) and in the part that is now missing, known as “phantom
pain.” Doctors are unsure exactly how this works, but to
the injured victim the phantom pain in his missing limb feels
as real and painful as if the missing limb were still attached.
Rather than feeling pain in the missing limb, some amputees
feel only phantom sensations, such as itching, burning, aching,
pressure, touch, wetness or dryness, hot or cold, or movement
in the missing limb.

Pain management is essential to the proper medical treatment
of amputees. There are two types of pain in amputation
cases: acute and persistent. Acute pain is usually severe in
intensity but lasts a relatively short time. Persistent pain generally
ranges from mild to severe and lasts for long periods of
time, sometimes years. In the beginning of treatment, when
pain is new and at its peak, it may be necessary to prescribe a
drug from that group of pain medications known as “opioids.”
This category of drugs includes morphine, oxycodone, and
codeine. Because of the risk of becoming addicted to an opioid
drug, after the critical stage has ended and the pain is less
intense, the doctor may switch the victim to a non-steroidal
anti-inflammatory drug (NSAID), such as ibuprofen (e.g., Advil
or Motrin), aspirin, acetaminophen (Tylenol), or naproxen
(Aleve). If severe pain persists despite the use of medications
and physical therapy, the victim may be referred to a pain management
doctor or clinic.

In many cases, a prosthesis (artificial limb) will enhance
an amputee’s mobility and ability to perform the “activities of
daily living” (ADLs), such as using the restroom by themselves,
dressing themselves, making their own meals, showering,
brushing their teeth, etc. A prosthesis must be fitted to the individual
and should be comfortable, functional, and cosmetically
appealing. Training by a skilled physical and/or occupational
therapist is necessary before and after receiving a prosthesis.
This training will help to maximize the functional use of the
artificial limb, and it will also help to prevent the development
of bad habits that may be difficult to break later.

While advances in medical treatments and surgical techniques
continue, over the past decade, improved outcomes
following amputation have largely been the result of advances
in prosthetic technology. For instance, for lower-limb (i.e.,
leg) amputees, the number of prosthetic feet that provide
“dynamic response” and the ability to maneuver on uneven
surfaces continues to increase. Additionally, at least one
microprocessor-controlled prosthetic foot-ankle unit is now
available. For above-the-knee amputees, there are currently
five different prosthetic knee units that use microprocessorcontrol.
These units allow for more normal knee motion and
stability through computerized parts that monitor motions
and forces and make extremely rapid real-time adjustments
while walking. This results in improved walking ability that
requires less effort.

For upper-limb (i.e., arm) amputees, the original bodypowered
(i.e., cable controlled) prosthetic designs remain in
common use, are the most durable, and continue to improve.
Although using electrical signals from the muscles (“myoelectric
componentry”) to control prostheses for the upper limb
has been in use for over 40 years, this technology continues to
advance, with associated further enhancements in function. To
improve the ability of high-level (close to or through the shoulder)
upper-limb amputees to use a myoelectric prosthesis, in
2006 a surgical technique called “targeted reinnervation” was
introduced, in which motor and sensory nerves are transferred
to the part of the body that needs healing in order to improve
motor control and sensory feedback during prosthetic use. The
application of this technique is still in its early stages.

In most cases, the amputation victim is measured for a prosthesis
several weeks after surgery, when the wound has healed
and the tissue swelling is decreased. The medical team will be
concerned with maintaining the proper shape of the residual
limb, as well as increasing overall strength and function. The
amputee will most likely need to make several visits for adjustments
with the professional who made the prosthesis (the prosthetist),
as well as extensive training with a physical therapist
to learn how to use it. They can help the amputee ease pressure
areas, adjust alignment, work out any problems, and regain the
skills the amputee needs to adapt to life after limb loss.

Some people are not good candidates for prostheses, and
these amputees will need to rely on mobility devices, such as
a wheelchair or crutches. For instance, a person who has had
both legs amputated (a “bilateral” amputee) may opt for a
wheelchair, while a person who has had only one leg amputated
(a “unilateral” amputee) may opt for a prosthesis. Of course, a
unilateral lower-limb amputee who has had a prosthesis made
for her may find it useful to use a cane or crutches for balance
and support in the early stages of walking. Whether to use a
prosthesis or a mobility device such as a wheelchair may be an
individual decision based on such factors as the person’s age,
balance, strength, and sense of security, as well as the location
and extent of the amputation.

Once the amputee has been fitted for a prosthetic limb, has
mastered (or is well on her way to mastering) its use, and feels
comfortable with its function, this is not the end of the road
for the amputee. She will still need to make periodic follow-up
visits to her doctor and prosthetist as a normal part of her life.
Proper fit of the socket and good alignment will ensure that the
prosthesis is still useful to the amputee and is not causing her
discomfort, pressure sores, or other problems. Artificial limbs
can break down over time and with continued use, and changes
in the physical shape and condition of the amputee’s residual
limb (i.e., the stump) may require the amputee to go in and have
adjustments made to an old prosthesis or get a new one made.
Even small problems with the prosthesis should be brought to
the immediate attention of the prosthetist. That way, the issue
can get attention before that small problem suddenly results
in the failure of the prosthesis and becomes a large problem,
resulting in further injury to the amputee.

After the amputee has had her surgery and has been fitted
for an artificial limb, she will need to keep a focus on the care
of the wound site and maintenance of the residual limb. Any
skin opening, whether it be for surgery or due to an improperly
fitted prosthesis, runs the risk of becoming infected by germs
entering the bloodstream through the opening. Infections can
cause tenderness or pain, fever, redness, swelling, and/or discharge.
These infections can lead to further complications that
will require medical intervention, even surgery. If the infection
is not treated in a timely manner, it is possible that the infection
will grow and spread, causing death.

The amputee will always need to pay special attention to
the hygiene of her residual limb, as it will be enclosed in the
socket or liner of the prosthesis and thus will be more prone
to skin breakdown and infections. If an amputee suspects that
she is getting an infection, she should promptly see her medical
doctor before it gets out of hand. If you are being fitted for a
prosthetic limb, ask your prosthetist for information on caring
for your residual limb to prevent infections and what to do if
you suspect you have one.

In addition to the intense physical pain and emotional discomfort,
the victim may suffer severe psychological trauma
that will require intensive and prolonged mental health care
intervention. Studies show that civilians suffering the loss of
a limb in, say, a traffic accident have a greater risk of experiencing
serious psychological problems than servicemen and
women who have suffered a traumatic amputation as a result
of, for example, the explosion of a roadside explosive device
while serving her country in the Middle East.

From a psychological viewpoint, losing a limb is one of
the most traumatic psychic events and losses you can suffer.
Initially, the victim will feel tremendous grief over the loss of
the limb. When the amputation is due to another person’s careless
act, the victim will at some point usually feel anger, even
rage, toward that person. And as time goes by, the victim may
fall into a deep clinical depression stemming from the loss of the
limb. A victim suffering from mental and emotional problems
arising from the loss of a limb should be treated by a psychologist
and/or psychiatrist. The victim will need psychotherapy
and, particularly in the case of depression, psychoactive medication
to treat her mental condition. An amputee may become
so despondent over the loss of her limb(s) that she attempts or
completes suicide.

Approximately 2.4 million burn injuries are reported each
year. About 650,000 of the injuries are treated by health care
professionals. Approximately 75,000 burn victims are hospitalized
each year. Of those hospitalized, 20,000 have major
burns involving at least 25 percent of their total body surface.
Between 8,000 and 12,000 patients with burns die, and several
hundred thousand sustain substantial or permanent disabilities
resulting from these injuries. Burn injuries are the second
leading source of accidental death in the United States, following
only the number of deaths resulting from motor vehicle
accidents.

TYPES OF BURNS

There are five major of types of burns: thermal burns, friction
burns, electrical burns, chemical burns, and radiation burns.

  1. Thermal Burns These are the most frequent type of burns
    and are caused by fire or excessive heat coming from such
    sources as steam, hot liquids, or contact with hot objects. In
    automobile collisions or motorcycle accidents, there is always
    the risk of a ruptured gas tank or loosened gas line igniting and
    catching fire, burning the people in the vicinity. Even when the
    person is removed from the source of the thermal burn, damage
    to his skin is still taking place and therefore the prompt administration
    of first aid is required. Depending upon their severity,
    thermal burns can cause anywhere from the minor discomfort
    of first-degree burns to life-threatening third-degree burns.
    In thermal burns, as well as other types of burns, the swelling
    and blistering of the burned skin is caused by the loss of fluid
    from damaged blood vessels. In severe cases, such fluid loss
    can cause shock. Immediate blood transfusion and/or intravenous
    fluids may be needed to maintain blood pressure. Due to
    the damage to the skin’s protective barrier, burns often lead to
    infection, which, if not treated promptly and appropriately, can
    result in life-threatening consequences, even death.
  1. Inhalation Burns Fire and heat have been associated
    with several types of inhalation injuries as well as burns to
    the flesh. (Inhalation injuries also occur with different types
    of burns, such as the inhalation of a caustic chemical.) When
    inhalation injuries are combined with external burns, the
    chance of death increases significantly.

The three types of inhalation injuries are:

    1. Damage from Heat Inhalation True lung burns
      occur only if the person directly breathes in hot air or a
      flame source, or high pressure forces the heat into him.
      In most cases, thermal injury is confined to the upper
      airways. However, secondary airway injury can occur if a
      person inhales steam, as it has a greater thermal capacity
      than dry air.
    2. Damage from Systemic Toxins Systemic toxins
      affect our ability to absorb oxygen. If someone is found
      unconscious or acting confused in the surroundings of
      an enclosed fire, the inhalation of systemic toxins could
      be a possible cause. More than a hundred known toxic
      substances have been identified in fire smoke. Toxin poisoning
      can cause permanent damage to internal organs,
      including the brain. Carbon monoxide poisoning can
      appear without symptoms up until the point where the
      victim falls into a coma.
    3. Damage from Smoke Inhalation Injuries that
      were caused by inhaling smoke can easily be missed
      because of more visible injuries, such as burns as a result
      of the fire. Sometimes this leads to the victim not receiving
      the necessary medical treatment due to the rescue
      teams taking care of the more severely burned victims
      whose injuries are more apparent. People who appear
      unharmed can collapse due to a major smoke inhalation.
      60 to 80 percent of fatalities resulting from burn injuries
      are due to smoke inhalation. Signs of smoke inhalation
      injury usually appear within 2 to 48 hours after the
      burn occurred. Symptoms of smoke inhalation include:
      (1) fainting, (2) evidence of respiratory distress or upper
      airway obstruction, (3) soot around the mouth or nose,
      (4) singeing of nasal hairs, eyebrows, and/or eyelashes,
      and/or (5) burns around the face or neck. Upper airway
      swelling (“edema”) is the earliest consequence of inhalation
      injury, and it is usually seen during the first 6 to
      24 hours after the injury. Early obstruction of the upper
      airway is managed by intubation. Initial treatment consists
      of removing the patient from the smoke and allowing
      him to breathe air or oxygen.
    4. Friction Burns This type of burn commonly occurs when
      a person is dragged along a surface. For instance, in a motor
      vehicle-motorcycle accident in which the motorcyclist is
      dragged a certain distance, he will likely sustain friction burns
      caused by the asphalt or cement unless he was wearing protective
      clothing. Joggers, pedestrians, and bicyclists are at high
      risk for friction burns when they are injured by an automobile
      or other motor vehicle. When a person has been dragged in an
      accident, he usually sustains abrasion injuries as well as a friction
      burn.
    5. Electrical Burns Contact between a person and an exposed
      live wire line or other electrical source is the cause of electrical
      burns. Contact with a high-voltage power source often results
      in limbs being severely burned as the electricity seeks a way out
      of the body. With some voltage sources, the person is unable
      to release his grasp on the power line or object, often resulting
      in electrocution. Besides the damage to the skin and limbs,
      electrical burns can severely affect the internal organs as well.
    6. Chemical Burns Chemical burns are caused by acids and
      other caustic substances, many of which are found in household
      cleaning products.
    7. Radiation Burns Radiation burns are caused by exposure
      to the sun, tanning booths, sunlamps, X-rays, radiation treatment
      for cancer, and nuclear medicine.

DEGREES OF BURNS

The severity of burns has traditionally been described in terms
of degree. First-degree burns are the most shallow (superficial),
and they affect only the top layer of the skin, the epidermis.
First-degree burns are red, moist, swollen, and painful, and
such burns may result in peeling and in severe cases, shock.
Second-degree burns extend into the middle layer of the skin,
the dermis, and often affect the sweat glands and hair follicles.
Second-degree burns are red, swollen, and painful, and they
develop blisters that may ooze a clear fluid. The skin may
be white or charred, and the person may go into shock. If a
deep second-degree burn is not properly treated, swelling and
decreased blood flow in the tissue can result in the burn receiving
a third-degree burn classification as the body’s condition
worsens.

Third-degree burns involve all three layers of the skin—the
epidermis, the dermis, and the fat layer—and usually destroy
the nerve endings as well. In third-degree burns, the skin
becomes leathery and may be white, black, or bright red, with
coagulated blood vessels visible just below the skin surface.
There is usually little pain with third-degree burns, as the
nerves have been destroyed, but the victim may complain of
pain. This pain is usually due to second-degree burns. Healing
from third-degree burns is very slow due to the skin tissue and
structures having been destroyed. Burns of this severity usually
result in extensive scarring. There are also fourth-degree
burns, which involve damage to muscle, tendon, and ligament
tissue.

The categorization of burns in terms of degrees is being
phased out in favor of one reflecting the need for surgical
intervention. The new language refers to burns as superficial,
superficial partial-thickness, deep partial-thickness, and
full-thickness.

Twenty-five years ago, people who suffered burns over
25 percent or more of their bodies were likely to die of their
injuries. Today, advances in medicine make it possible to save
many victims who have been burned over 90 percent of their
bodies. Of course, these survivors will have long-term impairment,
disability, scarring, and disfigurement, and they may
never get back to leading a normal life.

When burn damage is due to another person’s negligence,
that person must compensate the victim for all of her injuries:
financial, physical, and emotional. Over half of serious burn
victims are now treated in the approximately 200 hospitals
or clinics specializing in burn treatment. Many hospitals now
have trauma teams that are specially educated in the treatment
and management of burns.

TYPES OF SCARS

As burns heal, scars develop. There are three major types of
burn-related scars: (1) keloid (2) hypertrophic, and (3) contracture.
Keloid scars are an overgrowth of scar tissue that grows
beyond the site of the burn. Generally red or pink at first, they
become a dark tan over time. They occur when the body continues
to produce collagen, a tough fibrous protein, after the
wound has healed. Keloid scars are thick, nodular, ridged, and
itchy during formation and growth. Extensive keloids may
become binding and limit the person’s mobility. Additionally,
clothing rubbing or other types of friction may irritate this type
of scar. Dark-skinned people are more likely to develop keloid
scars than those with fair skin, and the possible occurrence
of keloid scars reduces with age. Keloid scars may be reduced
in size by freezing (cryotherapy), external pressure, cortisone
injections, steroid injections, radiation therapy, or surgical
removal.

Hypertrophic scars are red, thick, and raised, but unlike
keloid scars these do not develop beyond the site of injury or
incision. Additionally, hypertrophic scars will improve over
time. This time can be reduced with the use of steroid application
or injections.

The third type of scar, a contracture scar, is a permanent
tightening of skin that may affect the underlying muscles and
tendons; this can limit mobility, and there can be possible
damage or degeneration of the nerves. Contractures develop
when normal elastic connective tissues are replaced with inelastic,
fibrous tissue. This makes the tissues resistant to stretching
and prevents normal movement of the affected area. Physical
therapy, pressure, and exercise can help in controlling contracture
burn scars in many cases. If these treatments do not control
the effects of contracture scars, surgery may be required.
A skin graft or a flap procedure may be performed. The doctor
may recommend a newer procedure, such as Z-Plasty or tissue
expansion.

SURGICAL PROCEDURES TO IMPROVE SCARS

There are two major types of surgical procedures that can help
to conceal scarring and replace lost tissue for severe burn victims:
(1) dermabrasion and (2) skin grafts.

Dermabrasion is a surgical procedure to improve, smooth,
or minimize the appearance of scars, restore function, and
correct disfigurement resulting from a burn injury. Even with
dermabrasion, scars are permanent but their appearance will
improve over time. Dermabrasion may be performed in a dermatologic
surgeon’s office or in an outpatient surgical facility.

A skin graft is a surgical procedure in which a piece of skin
from one area of the person’s body is transplanted to another
area of the body. Skin from another person or animal may be
used as a temporary cover for large burn areas to decrease fluid
loss. The skin is taken from a donor site, which has healthy
skin, and it is then implanted at the damaged recipient site.
Skin grafts and flaps are more serious than other scar revision
surgeries, such as dermabrasion. They are usually performed
in a hospital under general anesthesia. Depending on the size
of the area and severity of the injury, the treated area may need
six weeks to several months to heal. Within 36 hours of the
surgery, new blood vessels will begin to grow from the recipient
area into the transplanted skin. Most grafts are successful,
but some may require additional surgery if they do not heal
properly.

The success of a skin graft can usually be determined within
72 hours of the surgery. If a graft survives the first 72 hours
without an infection or trauma, the body in most cases will not
reject the graft.

Before surgery, the recipient and donor sites must be free of
infection and have a stable blood supply. Following the procedure,
moving and stretching the recipient site must be avoided.
Dressings need to be sterile and antibiotics may be prescribed
to avoid infection.

For many severely burned persons, skin grafts using their
own healthy skin are not possible. These patients tend to have
very little healthy skin or they may not be strong enough for
the surgery. When other sources of skin must be used, options
can be cadaver skin or animal skin. The body will usually reject
both of these procedures within a few days and the surgery
will need to be performed again. A synthetic product called
Dermagraft-TC is made from living human cells and it is being
used now instead of cadaver skin. The FDA has approved
Dermagraft-TC and two artificial “interactive” burn dressings
for use in treating third-degree burns. Unlike traditional bandages,
some new dressings promote wound healing by interacting
directly with body tissues.

Other substitute skin products may become available soon.
Already, in addition to artificial skin, there is cultured skin.
Doctors are able to take a postage-stamp-sized piece of skin
from the patient and grow the skin under special tissue culture
conditions. From this small piece of skin, technicians can grow
enough skin to cover nearly the entire body in just three weeks.

COST OF TREATMENT/GETTING LEGAL HELP

Serious burns are one of the most expensive catastrophic injuries
to treat, and they can lead to lasting physical disability and
emotional damages. For instance, a burn of 30 percent of total
body area can cost several hundred thousand dollars in initial
hospitalization costs and physician fees. For more extensive
burns, there are additional significant costs, such as the cost of
multiple hospital admissions for reconstruction and rehabilitation.
Scars may heal physically but they remain visible and
last emotionally. Hence, it is of utmost importance if you have
been severely burned due to another person’s carelessness, that
you retain an experienced personal injury lawyer who understands
serious burn injuries. This type of lawyer can help you
get full compensation for the physical and emotional trauma
associated with the burns. You are entitled to recover all of your
medical expenses—past and future—lost wages, pain and suffering,
loss of enjoyment of life, and other damages.

A person who suffers a severe blow or jolt to the head or a penetrating
head injury may frequently develop a condition that
disrupts the function of the brain. This is known as a traumatic
brain injury (TBI). Auto accidents are a leading cause of TBIs,
as are falls, such as a slip and fall accident in a grocery store or
a trip and fall due to a defective walkway. TBI is a leading cause
of death and disability in the United States. Each year, 1.4 million
people sustain a traumatic brain injury. Fifty thousand of
those die from the TBI, 235,000 people are hospitalized, and
1.1 million people are treated and released from an emergency
room. The injury may be relatively minor, such as a minor concussion
or brief period of unconsciousness, or it may be severe,
such as a lengthy period of unconsciousness (a coma) or amnesia
after the injury. Each year, 80,000 to 90,000 people will
sustain a long-term disability as the result of a TBI. The Centers
for Disease Control and Prevention estimate that at least 5.3
million Americans currently have a long-term or lifelong need
for help to perform activities of daily living (ADLs) as a result
of TBIs.

The leading causes of traumatic brain injury are falls and
motor vehicle accidents, being struck by or against an object,
and assaults by another person involving traumatic injury to
the head. But TBIs need not be caused by a blow to the head. A
violent jolt of the head such as one might experience in a rearend
collision (“whiplash”) may result in serious brain injury. In
a violent collision, the head snaps forward and the brain hits
the front of the skull, then the head snaps backward and the
brain hits the back of the skull. These impacts can cause a serious
TBI. “Shaken-baby syndrome” is an example of a serious
brain injury being inflicted without a direct blow to the head.

Even in this age of advanced medicine and neurobiology,
there is no cure for a TBI. Improvement from a brain injury
depends on the brain’s “plasticity,” that is, the brain’s ability to
“rewire” itself and have other areas of the brain take over the
functions of the damaged areas.

Brains do not heal like broken limbs, and each person’s
brain is different. Although they may superficially appear alike,
no two brain injuries are the same and the consequence of two
similar traumatic brain injuries may be vastly different.

Health care professionals who deal with TBIs do not talk
in terms of “recovery,” but rather “improvement.” The word
“recovery” implies that that the effects of a TBI will disappear,
whereas the reality is that improvement is usually all that can
be expected. With a TBI, some of the effects may disappear
after a couple of years or more, but more frequently these longterm
changes linger on, changing only slowly—if at all—over
the person’s lifetime.

CATEGORIES OF TBI

TBIs are classified into three categories: mild, moderate, and
severe.

  1. Mild Traumatic Brain Injury A person with a mild TBI
    is one who has suffered trauma to the brain and: (a) had any
    period of loss of consciousness and/or confusion, (b) was
    disoriented or confused for less than 30 minutes, and/or (c)
    suffered from Posttraumatic Amnesia (PTA) (loss of memory
    for events immediately before or after the accident). Mild TBI
    is the most common type of TBI, and it is often missed at the
    time of the initial injury. Fifteen percent of people with mild
    TBIs have symptoms that last one year or more.
  2. Moderate Traumatic Brain Injury Moderate TBI exists
    when a person has suffered trauma to the brain and: (a) lost
    consciousness for at least 20 minutes to six hours and/or (b)
    suffered from Posttraumatic Amnesia for more than 30 minutes
    but less than 24 hours. It also applies where the person has
    suffered a skull fracture. Moderate TBI may result in long-term
    physical or cognitive deficits, depending on the type and location
    of the brain injury. Rehabilitation will help to overcome
    some deficits and provide skills to cope with any remaining
    deficits.
  3. Severe Traumatic Brain Injury A severe brain injury is
    a life-threatening condition in which: (a) the person loses consciousness
    for more than six hours or (b) has Post Traumatic
    Amnesia lasting longer than 24 hours. If the person lives, she
    will typically be faced with long-term physical and cognitive
    impairments, ranging from a persistent vegetative state to less
    severe impairments that may allow the person, with extensive
    rehabilitation, to continue to function independently.

DAMAGES DUE TO TBI

Symptoms common to mild TBIs include fatigue, headaches,
visual disturbances, memory loss, poor attention and/or concentration,
sleep disturbances, dizziness and/or loss of balance,
irritability, feelings of depression, and, rarely, seizures.
Other symptoms associated with mild TBIs include nausea,
loss of smell, sensitivity to sound and lights, getting lost or
confused, and slowness in thinking. Sometimes the cognitive
symptoms are not readily identified at the time of the injury,
but instead may show up as the person returns to work, school,
or housekeeping. Friends and colleagues may notice changes in
the person’s behavior before the injured person realizes anything
is wrong.

A person who has suffered a moderate or severe TBI may
suffer from such cognitive deficits as difficulties with attention,
concentration, distractibility, memory, speed of processing
information, confusion, impulsiveness, language processing,
and what are often referred to as “executive functions.”
Executive functions refer to the complex processing of large
amounts of intricate information that we need to function creatively,
competently, and independently as beings in a complex
world. After a severe TBI, the person may be unable to function
well in her social roles because of difficulty in planning ahead,
keeping track of time, coordinating complex events, making
decisions based on broad input, adapting to changes in life, and
otherwise “being the executive” in her own life.

Some of the difficulties resulting from a moderate to severe
TBI include speech and language problems, such as not understanding
the spoken word, difficulty speaking and being understood,
slurred speech, speaking very fast or very slowly, and
issues with reading and writing. Sensory problems include
difficulties with the interpretation of touch, being aware of
changes in the temperature, and limb position. Partial or total
loss of vision, weakness of eye muscles and double vision,
blurred vision, difficulties judging distance, involuntary eye
movements, and intolerance of light are other problems frequently
found with moderate to severe TBIs.

Physical changes include paralysis, chronic pain, loss of
bowel and bladder control, sleep disorders, loss of stamina,
changes in appetite, difficulty regulating body temperature,
and menstrual problems. Moderate to severe TBIs can cause
a wide range of functional changes affecting thinking, language,
learning, emotions, behavior, and sensation. TBIs can
also cause seizures and increase the risk for such conditions
as Alzheimer’s disease, Parkinson’s disease, and other brain
disorders that become more likely as the person grows older.

A common complaint among persons who sustain a TBI
is fatigue. Studies of people with TBIs found that between 37
and 98 percent of them said they had some type of fatigue.
There are three types of fatigue: (1) physical fatigue: feeling
tired and a need to rest and having muscle weakness, (2)
psychological fatigue, in which the person can’t get motivated
to do anything, is often accompanied with depression (50-60
percent of people who suffer a TBI develop major depression,
which affects only about 5 percent of the general population
at any one time), anxiety (about twice the rate of the general
population), Posttraumatic Stress Disorder (PTSD) and other
psychological conditions, which may take months or years of
psychotherapy to treat and may require psychoactive medication,
and (3) mental or cognitive fatigue, in which the person
has difficulty concentrating and finds it hard to stay focused,
becomes irritable, or has headaches.

LONG TERM EFFECTS OF TBI

The long-term effects of a TBI depend on a number of factors,
including: (1) the severity of the initial injury, (2) the rate and
completeness of physiological healing, (3) the types of functions
affected, (4) the resources available to aid in the recovery
of function, and other factors. Most spontaneous improvement
from a TBI occurs within the first month after a brain injury.
Some additional gains may occur over the next three to six
months. The long-term effects of a TBI are different for every
person. Some may experience only subtle difficulties, others
will have moderate dysfunction, while to still others the TBI
may be life-threatening. With TBIs, the systems in the brain
that control our social-emotional lives are often damaged. The
consequences for the individual and his significant others may
be very difficult, as these changes may imply to them that “the
person who once was” is no longer there. Personality can be
substantially or subtly modified following injury. The person
who was once an optimist may now be depressed. The previously
tactful and socially skilled negotiator may now be blurting
comments that embarrass those around them. The person
may also be characterized by a variety of other behaviors:
dependent behaviors, emotional swings, lack of motivation,
irritability, aggression, lethargy, lack of inhibition, and being
unable to modify behavior to fit varying situations.

The severity of the injury and the resulting direct effects on
the individual’s body systems and cognitive abilities may not
predict the amount of impact the TBI has on a person’s life.
For example, a severe injury to the frontal brain area may have
less impact on an agricultural worker’s job performance than a
relatively mild frontal injury would have on a physicist’s work.
Hence, the extent of injury and damages in a specific person’s
life will depend on his pre-injury lifestyle, personality, goals,
values, and resources, as well as his ability to adapt to changes
and to learn techniques for minimizing the effects of brain
injury.

WORKING WITH A LAWYER

If you or a loved one has suffered a traumatic brain injury due to
another person’s carelessness—such as an automobile accident
caused by another person’s inattentiveness or a slip and fall on
a store’s slippery floor—it is important that you promptly seek
representation by a personal injury law firm experienced in this
type of injury. Monetary damages you are entitled to receive
when you have sustained a traumatic brain injury include all of
your medical and rehabilitation costs, lost wages because you
were unable to return to work, loss of enjoyment of life due to
your impaired condition, pain and suffering, and psychological
damage.

If you suffer an injury that severs or compresses the spinal cord
in your neck or back, there is a good chance that you will be
paralyzed from the point of injury downward for the rest of
your life. This is called a “spinal cord injury,” or SCI for short.
A little neurology and anatomy will be of immense help here.

The central nervous system (CNS) is made up of two parts:
the brain and the spinal cord. The spinal cord runs from the
base of the brain down the back to the tailbone. The spinal cord
is protected by the spinal column, which consists of bones with
a hole in the middle of them. These bones are called the vertebrae.
At the top of the spinal cord are seven vertebrae known
as the cervical vertebrae (C-1 to C-7, in descending order).
Running down the back are the 12 “thoracic” vertebrae (T-1 to
T-12), which are in turn followed by the five “lumbar” vertebrae
(L-1 to L-5). The “sacrum” (S-1 to S-5) and the “coccyx” (tailbone)
make up the remainder of the spinal column. Injuries
to the cervical spine resulting in paralysis of the body below a
certain point are known as quadriplegia (also called tetraplegia),
while injuries to the spinal column at or below the thoracic
level are classified as paraplegia.

The cervical spinal nerves control signals to the back of the
head, the neck and shoulders, the arms and hands, and the diaphragm.
The thoracic spinal nerves control signals to the chest
muscles, some muscles of the back, and parts of the abdomen.
The lumbar spinal nerves control signals to the lower part of
the abdomen and the back, the buttocks, some parts of the
external sex organs, and parts of the leg. Sacral spinal nerves
control signals to the thighs and lower parts of the legs, the
feet, most of the external sex organs, and the area around the
anus. As you can see, the higher the SCI to the spine, the more
disabling—and potentially fatal—the injury. For instance, a
spinal cord injury at the neck level may cause paralysis in both
arms and legs and make it impossible for the victim to breathe
without a respirator, while a lower injury may affect only the
legs and lower parts of the body.

SCIs involving the cervical vertebrae usually cause loss of
function in the arms and legs, known as quadriplegia (or tetraplegia).
If the SCI is at or above the C-3 level (C-1 to C-3),
then the ability to breathe on one’s own is affected, and it will
probably be necessary to have a mechanical ventilator for the
person to breathe, as was the case for actor Christopher Reeve
after his tragic accident until his death. Many people with SCI
at or above C-3 die before receiving medical treatment because
of their inability to breathe. C-4 is a critical level, as it is the
level where nerves to the diaphragm—the main muscle that
allows us to breathe—exit the spinal cord and go to the breathing
center.

Besides allowing for regulation of the breathing process,
injuries at C-4 may also allow the person some use of his biceps
and shoulders, but this will be fairly weak. Injuries at the C-5
level often result in shoulder and biceps control, but no control
of the wrist or hands. If the SCI is at the C-6 level, the victim
usually has wrist control, but no hand function. Victims with
SCI at the C-7 level can usually straighten their arms, but may
still have dexterity problems with the hands and fingers. Injury
at or below the C-7 level is generally considered to be the level
for functional independence.

If the SCI is at the T-1 to T-8 levels, the victim usually has
control of his hands, but poor trunk control resulting from a
lack of abdominal muscle control. Lower thoracic vertebra injuries
(L-9 to L-12) allow good trunk control and good abdominal
muscle control, and the victim’s sitting balance is very good.
SCI to the lumbar and sacral regions result in decreasing control
of the legs and hips, urinary system, and anus.

It is often impossible for the doctor to make a precise prognosis
right away, and emergency doctors are advised not to make
prognoses on the question of paralysis. There is no cure for an
SCI, but the sooner the intervention, the better the chances of
minimizing the damage. For example, a corticosteroid drug
(methylprednisolone) administered within eight hours of the
time of injury may reduce swelling, which is a common cause
of secondary damage. An experimental drug currently being
studied appears to reduce loss of function.

On about the third day of hospitalization following the
injury-producing incident, the doctors give the victim a complete
neurological examination to determine the severity of
the injury and predict the likely extent of recovery. X-rays, CT
scans, MRIs, and more advanced imaging techniques are also
used to visualize the entire length of the spine.

Recovery, if it occurs, typically starts between a week and
six months after the injury is sustained, especially as the swelling
goes down. The majority of recovery occurs within the
first six months after injury. Impairment remaining after 12
to 24 months is usually permanent, although with incomplete
SCIs, the person may recover some functioning as late as 18
months after the injury. However, some people experience
small improvements for up to two years or longer. For instance,
Christopher Reeve regained the ability to move his fingers and
wrists and feel sensations more than five years after he sustained
a SCI to his cervical spine in a horse-riding accident. But
the fact remains that only a very small fraction of persons who
sustain an SCI will recover significant functioning.

Besides a loss of motor functioning and feeling below the
level of injury, depending upon the level of the SCI, persons
with SCI may experience other difficulties, such as:

  • Pain or an intense stinging sensation caused by damage
    to the nerve fibers in the spinal cord
  • Loss of sensation, including the ability to feel heat, cold,
    and touch
  • Difficulty breathing, coughing, or clearing secretions
    from the lungs
  • Loss of bladder or bowel control
  • Pressure sores from sitting or lying in the same position
    for a long period of time (also called bedsores or “decubitus
    ulcers”)
  • Inability or reduced ability to regulate heart rate, arrhythmias
    (irregular heart beats), blood pressure, sweating,
    and, hence, body temperature
  • Exaggerated reflex activities or spasms (spasticity)
  • Atrophy of the muscles
  • Blood clots, especially in the lower limbs (e.g., Deep Vein
    Thrombosis, commonly known as DVT) and in the lungs (pulmonary embolism)
  • Osteoporosis (loss of calcium) and bone degeneration
  • Mental depression, often resulting in suicide or attempted
    suicide

The damage to the nerve may be complete or incomplete.
With complete damage, there is a total loss of sensory and
motor function below the level of the SCI; there is no movement
and no feeling below the level of injury, and both sides of
the body are equally affected. With incomplete damage, there
is some functioning and/or sensation below the site of the SCI.
For instance, a person with incomplete damage may be able to
move one leg more than the other, may be able to feel parts of
the body that cannot be moved, or may have more functioning
on one side of the body than the other. The extent of an
incomplete spinal cord injury is generally determined after
spinal shock has subsided, approximately six to eight weeks
after the injury is sustained. With advances in acute treatment
of SCI, incomplete injuries are becoming more common than
complete SCI injuries.

Accidents involving automobiles, motorcycles, and other
motor vehicles, especially with Sport Utility Vehicles (SUVs)
and 15-passenger vans rolling over, are the most common
causes of SCIs. Spinal cord injuries due to violent acts—such
as being shot or stabbed—are the second-most common type
of SCI, and they are the leading type of SCI in some urban
settings in the United States. SCIs due to falls are the thirdmost
common type, occurring most frequently in persons aged
65 years or older. Recreational sports injuries (discussed in
Chapter 15) are the fourth-most common cause of SCIs, with
diving in shallow water being the sport that causes the most
SCIs of all recreational sports, followed by impact in high-risk
sports such as football, rugby, wrestling, gymnastics, surfing,
ice hockey, and downhill skiing.

There is the risk of an earlier death for a person who suffers
a SCI. The most common cause of death of SCI victims is
diseases of the respiratory system, especially pneumonia. The
second leading cause of death is non-ischemic heart disease;
this almost always involves unexplained heart attacks, often
occurring among young persons who have no previous history
of underlying heart disease. Suicide is the cause of death in a
substantial number of persons who sustain a SCI. Other leading
causes of death involving an SCI are pulmonary emboli and
septicemia (infection of the blood stream). Death rates are significantly
higher during the first year after injury than during
subsequent years, particularly for severely injured persons.

The financial and emotional costs associated with paraplegia
and quadriplegia are enormous. The average length of the
initial hospitalization following injury in acute care units is 15
days. The average stay in a rehabilitation unit is 44 days. The
victim of a serious SCI will often have to go through extensive
and exhaustive rehabilitation and physical therapy. Persons
suffering from a serious SCI are generally treated at a regional
SCI spine center. The initial hospitalization costs following an
SCI are in the range of several hundred thousand dollars for
paraplegics and over half a million dollars for quadriplegics.
The average lifetime medical costs for victims becoming paraplegics
at the age of 25 can easily top $1 million. The average
lifetime costs for victims who become quadriplegics at age 25
easily reaches into the area of several million dollars.

If you were injured in an automobile collision or other type
of accident caused by another person that resulted in broken
bones, you have the right to recover monetary compensation
for all of your injuries and associated costs. Common causes
of bone fractures include motor vehicle accidents, falls from a
height, a direct blow to the bone, child abuse, and repetitive
forces, such as those produced by running, causing stress fractures
of the foot, ankle, tibia, or hip.

One source says that the most commonly fractured bone is
the collar bone (“clavicle”), usually as the result of an automobile
accident. Another source lists breaks of the wrist, hip, and
ankle as the most common fractures. A break or a crack in a
bone is known as a fracture and can affect any bone in the body.
A simple (or “closed”) fracture is a clean break to the bone that
does not damage any surrounding tissue or break through the
skin. The only way of certainty in diagnosing a closed fracture
is with an X-ray, CT scan, or MRI.

A compound (or “open”) fracture occurs when the surrounding
soft tissue and skin is damaged, such as where the broken
bone penetrates through the skin. The attending emergency
room physician will order X-rays or other imaging studies performed
so she can find out exactly the extent of injury. This
kind of fracture is more serious in large part because there is a
high risk of infection since it is an open wound.

Additionally, a “simple” fracture is one that occurs along one
line, splitting the bone into two pieces, while “multi-fragmentary”
fractures, known as “comminuted fractures,” involve the
bone splitting into multiple pieces. A simple closed fracture is
much easier to treat and has a much better prognosis for full
recovery than an open comminuted fracture. Another type of
bone fracture is a “compression fracture,” which usually occurs
in the vertebrae (the bones that make up the spinal column).
There are approximately 14 different types of fractures.

Fractures are most frequently a result of an accident such
as a bad fall or motor vehicle collision. The time it takes for a
bone to heal depends on the type of fracture, where it is, and
if it is an open or closed fracture. Healing of a broken bone is
a gradual process, and it can take anywhere from a few weeks
to several months. The healing process may, in fact, take even
longer in some cases, such as in the presence of chronic diseases
like osteoporosis and diabetes. As a person gets older,
their bones become weaker making the individual more prone
to fractures if they fall. Young children get different types of
fractures because their bones are more elastic. They also have
growth plates at the ends of the bones that can be damaged.

In order for a fracture to heal as well as possible, a good
placement (“reduction”) of the bones must be attained. When
doctors talk about “reduction” of a fracture, or “reducing” the
broken bone, they are talking about improving the alignment of
the broken ends of the bone. In most cases reducing a fracture
may involve a little pulling and tugging of the bones to attain
optimal alignment. Once the bones are properly aligned, a plaster
or fiberglass cast will be applied to hold the bones in the
proper position while they heal.

A plaster cast molds to the skin better and is preferred if the
broken bone needs to be held in a specific place. If the fracture
is not unstable, or if some healing has already taken place, a
fiberglass cast may be used. In many cases, physical therapy is
required after the fracture has healed and the cast is taken off
to strengthen the muscles and restore mobility in the affected
area. Fractures near or through joints may result in the joint
becoming permanently stiff or being unable to bend properly.
In such a case, the lawyer will argue that the patient/client is
entitled to recover a higher monetary award to compensate
the injured person for the added pain and suffering, lack of
enjoyment of life, and work prohibitions that the victim will
experience.

If the bones cannot be properly aligned or are not sufficiently
stable, and reduction cannot be satisfactorily achieved,
then surgery is often necessary. In one type of surgery, “internal
fixation,” an orthopedic surgeon aligns the fractured bones
with pins, plates, screws, or rods. A second type is “external
fixation.” Here, the pins or screws are placed into the broken
bone above and below the fracture site. The orthopedic surgeon
then repositions the bone fragments, and the pins or screws are
connected to a metal bar or bars outside the skin. The external
fixation devices hold the bones in the proper position so they
can heal. After an appropriate amount of time, the external
fixation devices are removed.

Occasionally the orthopedic surgeon uses “bone grafting” to
treat a fracture. A bone graft is surgery to place new bone into
spaces around a broken bone or bone defects. The new bone
can be taken from the patient’s own healthy bone (an “autograft”),
from frozen, donated bone (“allograft”), or an artificial,
synthetic, or natural substitute for bone. Bone grafting is used
to repair bone fractures that are extremely complex, pose a significant
health risk to the patient, or fail to heal properly. The
new bone is held in place with pins, plates, or screws. Stitches
are used to close the wound, and a splint or cast is usually used
to prevent injury or movement while the bone is healing.

Bone grafts are used to fuse joints to prevent movement,
repair broken bones (fractures) that have bone loss, and to
repair bone that has not healed. Surgeons use bone grafts to
repair and rebuild diseased bones in the hips, knees, spines,
and sometimes other bones and joints. Most bone grafts help
the bone defect to heal with little risk of graft rejection, and
recovery time generally varies from two weeks to two months,
depending on the injury or defect being treated. Vigorous exercise
is usually prohibited for up to six months.

If you have suffered a broken bone due to another person’s
carelessness (“negligence”), you are entitled to recover your
medical expenses, lost wages, pain and suffering, and loss of
enjoyment of life you endured from the party that negligently
injured you, as well as the lost wages for the time you are off
work for surgery, recovery, and physical therapy. Recoverable
medical expenses include visits to the emergency room, your
primary care provider, an orthopedic specialist, and the costs
of having a cast made for you. If the break results in a deformity
or limp that you will have to live with for the rest of your life,
you are entitled to receive damages for that as well.

Whiplash has been the butt of many jokes and parodies over the
years. However, the fact is that it can be a serious injury requiring
medical attention and extensive physical therapy. Whiplash
occurs when the head is snapped suddenly and violently forward
then backward, as would happen if you collided with a car
that suddenly pulled out in front of you. Severe whiplash can
result in injury to the intervertebral joints, discs, ligaments,
and nerve cases. In especially severe cases of whiplash, surgery
may be necessary to repair damage to the soft tissue. Between
15 and 40 percent of people who suffer whiplash will continue
to have pain months after the injury was sustained. There is an
18 percent chance that a whiplash victim will still be experiencing
some symptoms more than two years after the accident.

Whiplash injuries may not show up right away; a person may
awaken several days or a week or two later with classic signs of
whiplash, such as neck pain, shoulder stiffness, and headache.
Usually, the sooner the symptoms of whiplash appear, the
more serious the injuries tend to be. Depending on the severity
of the whiplash, the doctor may order the patient to wear
a cervical (neck) collar, take anti-inflammatory drugs such as
aspirin, ibuprofen (e.g., Advil or Motrin), or naproxen (Aleve).
For people who are suffering greater than normal pain, the
doctor may prescribe strong prescription pain relievers, such
as Vicodin and Norco, as well as muscle relaxants. The doctor
may also prescribe physical therapy for the victim for a period
of several months or more, depending upon how the victim is
recovering. While the majority of whiplash victims recover in
six to twelve weeks, for some people, regardless of the brace,
medications, and physical therapy, whiplash results in longterm
symptoms which can be extremely painful and disabling.

In addition to “simple” whiplash, there is the more serious
Whiplash-Associated Disorder (WAD). In the more severe and
chronic cases of WAD, the person may experience depression,
anger, frustration, anxiety, stress, drug dependency, alcoholism,
substance abuse, Posttraumatic Stress Disorder (PTSD),
insomnia, and social isolation. In some cases, the snapping
motion of the neck is so strong that it may cause the dislocation
or even a fracture to a cervical vertebra, causing paralysis. (See
Chapter 29 for a discussion of Spinal Cord Injuries.)